Provider Demographics
NPI:1932558996
Name:MILES, ANDREW LANE (PA)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:LANE
Last Name:MILES
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 E PHILLIPS RD
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-4815
Mailing Address - Country:US
Mailing Address - Phone:864-235-2335
Mailing Address - Fax:864-877-1260
Practice Address - Street 1:2700 E PHILLIPS RD
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-4815
Practice Address - Country:US
Practice Address - Phone:864-235-2335
Practice Address - Fax:864-877-1260
Is Sole Proprietor?:No
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCTL2556363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant